Physician assistants could save the health care system more than a billion dollars over the next 13 years, says a Conference Board of Canada study released Monday.

There are only about 550 physician assistants (PAs) currently working in Canada. PAs act as “physician extenders” whose scope of practice depends on their relationship with the doctors they work for, performing tasks such as conducting interviews with patients and taking medical histories, performing exams, offering preventative counseling and, in some cases, providing medical orders and prescriptions.

PAs could relieve some of the pressure on the doctors’ time, decrease wait times and alleviate workplace shortages just as the aging population starts to increase demand on the system, according to the study, which engaged an expert panel to advise a team of economists on which tasks could be delegated to PAs, increasing the total number of patients a doctor could see.

PAs don’t replace doctors, but they can take on many routine tasks, giving doctors more time to spend with complex cases and in their areas of specialty, said Matthew Stewart, the Conference Board’s assistant director of national forecast.

“There’s a lot of evidence that they’re effective and have good patient outcomes,” he said.

The study compared projected demand on health care as far as 2030 and constructed scenarios where some of the demand on doctors was assigned to PAs. The greatest potential gains were in family practice, orthopedics and emergency rooms. According to the model, PAs can increase the time doctors have to spend with patients by up to 45 per cent.

“Part of the struggle has been to have the data from the financial perspective,” said Chris Rhule, president of the Canadian Association of Physician Assistants, which funded the study. “The government is always looking at costs. This (study) enables us to show that it’s a very efficient model.”

The provincial colleges of physicians and surgeons have been very welcoming to PAs, but governments have been wary, he said. PAs are regulated in only two provinces, Manitoba and New Brunswick.

Regulation has proved to be a substantial barrier. In Manitoba, where Rhule works as a PA in cardiac surgery, PAs can write prescriptions and orders for diagnostic tests without the need for a doctor to co-sign. His counterparts in Ontario don’t have the same scope of practice.

Dr. Granger Avery, president of the Canadian Medical Association, said adding PAs to the system is a good idea. He points to home visits as one area where they would be useful.

“The best way to work is in a team. Anything to help improve the team approach is good,” said Avery. “We’re the land of 100,000 health-care silos. Some are silos of excellence. But we need to help them connect.”

There are only four two-year programs that train PAs in Canada, graduating a total of about 80 students a year. It would be possible to increase the numbers of PAs in Canada to 2,550 by 2030.

PAs have only worked in Canada for about 10 years. One study in the U.S., where PAs have been part of the medical landscape for 50 years, found PAs can be delegated to substitute for doctors in about 85 per cent of primary care tasks. An Australian study found that they can manage up to 62 per cent of all patients in emergency room environments.

Stewart said there has been little study on the impact of PAs on the medical system in Canada. While they could help save over $1 billion by 2030, the entire health care system spends about $219 billion a year, so PAs are only a part of the answer.

Rhule compared the aging population to a rising tide. “The water is up to our shoulders. Soon we’ll be struggling to meet demand. We need all hands on deck. PAs are one more piece of the puzzle.”

By the numbers:

550: Number of physician assistants currently working in Canada

2,550: Number by 2030, according to the Conference of Canada projection

1,400: How many more physicians would be needed each year to fulfil population demand

$43: Hourly earnings of a physician assistant

$150: Hourly earnings of a primary care physician

45 per cent: Increase in the proportion of time that would be freed for doctors to spend with patients by assigning certain tasks to physician assistants

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